A Randomized Trial to Reduce Problematic Use of Amphetamine Type

Stimulants

Robert Tait, Rebecca McKetin, Frances Kay-Lambkin, Bradley Carron-Arthur, Anthony Bennett, Kylie Bennett,

Helen Christensen, Kathleen M. Griffiths

robert.tait@curtin.edu.au

Burden of diseaseSystematic reviewsbreakingtheice

Burden of diseaseSubstance Global Australia

Alcohol

DALYs (%)harm

deaths (n)

4.01 787000

2.31084

Illicit drugs

DALYs (%)

deaths (n)

0.8223000

2.01705

BoD Rehm, Taylor & Room Addiction 2006: Begg AIHW 2007

Amphetamine type stimulants (ATS)

UNODC 2010

Amphetamine type stimulants (ATS)

Primary drug of concernAfrica 5%Asia 20% (>80% Cambodia, Korea, Thailand)Australia 21%Europe 9% (Czech 61%, Iceland 39%: Sweden

35%)N. America 13% (Guatemala 42%, Canada 3%, USA

13%)

UNODC 2010

Alcohol interventionsBrief in person interventions (Moyer Addiction 2002)

BI versus Control (non-treatment seeking - excluding severe problems) • Small – medium effects (e.g. d ≈ .26 at 12 months)• Alcohol and composite measures improved• Effective to 12 months

Alcohol: self-guided interventions for adult problem drinkers (Riper 2011)

•Overall g = .39 •Single session g = .27 (typically normative feedback)•Multi session g = .61•Max follow-up 9 monthsOnline alcohol interventions (White et al 2010)

•Overall d =.42•Attracted young (early 20s) people•Higher % of women than face-to-face studies

Online cannabis interventions (Tait et al 2013)

10 studies: n = 4125Prevention n = 5‘Treatment’ n = 570% < 6 months follow-up: only 1 study >12

monthsRetention 16%-95%(High retention in mother-daughter dyad trials)•Overall g = .16

BreakingtheiceDesign: RCT Intervention versus wait list controlTarget: users of amphetamine type stimulants (ATS)Program: three modules, fully automated and self-guided

Baseline Control (79) Intervention (81)

Sex male n (%) 57 (72)a 64 (79)Age mean (SD) 22.5 (7.1) 22.2 (5.5)Age 1st ATS use mean (SD) 18.6 (4.2) 17.7 (2.6)SDS mean (SD) [threshold > 5] 3.8 (3.3) [42%] 3.7 (3.5) [30%]ATS Fq last 3 months 1-2 n (%) 27 (34) 20 (25)

monthly n (%) 18 (23) 33 (41)weekly n (%) 23 (29) 21 (26)

daily / almost daily n (%) 11 (14) 7 (9)ASSIST ATS score mean (SD) 16.8 (11.1) 17.0 (10.1)

BreakingtheiceSecondary outcomes•Kessler-10 (Psychological distress)

•EUROHIS (Quality of Life)

•Poly-drug use (number of ASSIST categories)

•Intended help-seeking (for ATS use)

•Actual help-seeking (for ATS use)

•Days out of role

•Days partially out of role

•Readiness to change (category)

Study cohort

Baseline 3 months 6 months

BreakingtheiceResults

AS

SIS

T A

TS

sco

re

d=0.07 (control favoured)

BreakingtheiceD

ays

out

of r

ole

K-1

0 m

ean

scor

e

d=0.12 d=0.12 (control favoured)

BreakingtheiceIn

tend

ed H

elp-

seek

ing

Act

ual H

elp-

seek

ing

d=0.32d=0.45

RR. 2.33, 95% CI, 1.07-5.10

Breakingtheice‘Exposure’ completing > 1 modules (n=51): 0 modules (n=30): control (n=79)

N.B. No longer RCT• Intended help-seeking (p=.014)• Actual help-seeking (p=.034)• Days out of role (p=.007)

DiscussionFindings 1st intervention designed for ATS users

Improves actual help seekingMay reduce days out of role & increase help-seeking intentions

Limitations Attrition 51%Representativeness of all ATS users?Type 1 errors

Implications Still in its infancy

Modules focus: motivation versus quitting

Adjunct to face-to-face interventions?

AcknowledgementsThis study was funded by The Commonwealth of

Australia, Department of Health and Ageing

Helen Christensen is funded by NHMRC Fellowship 1056964 Kathleen Griffiths is funded

by NHMRC Fellowship 525413 Frances Kay-Lambkin is funded by NHMRC

Fellowship 1008972.

Robert Tait is funded by a Curtin University Research Fellowship